Medical issues

Medical reviews in the visa process can cause huge processing delays, and in the worst case scenario can lead to visa decline if not handled in a competent way. We are experts in this area, and assist applicants on a weekly basis to successfully deal with medical issues raised during visa processing.

Immigration New Zealand medical assessor assessments and opinions.

We would like to make two initial general observation points here based on our many years of experience in this area. First, the initial opinion from the Immigration New Zealand medical assessor should never be accepted at face value to be correct, or taken that the assessor is applying the medical related visa policy correctly. In many instances a consultant physician and/or specialist will completely disagree with the opinion of the medical assessor, or we will identify that the medical assessor has applied the wrong standard/policy so even though there is a medical issue it is not serious enough to decline the actual visa being applied for.

Second, the term “relatively high probability” is a term which is not readily understood or applied correctly by Immigration New Zealand visa processing officers nor their medical assessors. This term is often raised in Immigration New Zealand letters raising medical concerns with an applicant.

The term “relatively high probability” is not a civil standard of proof being more likely than not (over 50% chance) treatment will be required, nor is it a criminal standard of proof which is beyond reasonable doubt; it lies somewhere in between. Therefore, there must not merely be a remote or simple possibility that treatment and/or costs will be incurred (i.e. a less than 50% chance), it must be demonstrated that there is a relatively high probability that costs and/or treatment will be required in order for an individual to potentially fail health requirement, which would represent well over a 50% chance of treatment, but below 100% (certainty).

Our firm has taken over many applications where issues have been encountered with the medical assessor that we have been able to successfully challenge and reverse out on these two points, sometimes we have dealt with them both in a single application.

The point here, simply, is that if during the processing of an application if you receive a potentially prejudicial information letter stating that you may not meet the applicable standard of health, do not accept this at face value, and seek a professional opinion.

Acceptable standard of health – temporary class visa applications

Contrary to belief there are relatively few medical conditions that prevent an applicant obtaining a temporary visa. That is because the potential for treatment is viewed in the context of the duration of the temporary visa sought, not the life of the condition (which is the resident visa focus).

In order to fail the acceptable standard of health for a temporary visa, there must be a “relatively high probability” that the applicant will require:

hospitalisation;

residential care;

high cost pharmaceuticals; and/or

high cost disability services;

During the term of the visa requested. If any of these conditions apply, contact us prior to making an application.

There are different ways to manage this process, and when the issue needs to be tackled. In addition in many cases there are ways to secure a visa as an exception to the requirements, especially so if the applicant has a residence application processing or a demonstrated pathway for such an application. Seek an opinion from us to put you in an informed position to decide what to do.

Acceptable standard of health – residence class visa applications

There are essentially two tiers operated by Immigration New Zealand to determine whether or not an individual is able to demonstrate an acceptable standard of health in a residence application.

First, a list of medical conditions that will be deemed to not meet the acceptable standard of health and therefore will require a medical waiver in order for the application to be approved is available.

The current list of health conditions which indicate that an individual is not of the acceptable standard of health is as follows:

Health conditions which indicate that an individual is not of the acceptable standard

HIV infection;

Hepatitis B-surface antigen positive and meeting criteria for anti-viral treatment in New Zealand;

Hepatitis C-RNA positive and meeting criteria for anti-viral treatment in New Zealand;

Malignancies of organs, skin (such as melanoma) and haematopoietic tissue, including past history of, or currently under treatment. Exceptions are:

treated minor skin malignancies;

malignancies where the interval since treatment is such that the probability of recurrence is greater than 10 percent.

Requirement for organ transplants (with the exclusion of corneal grafts), or following organ transplant when immune suppression is required (with the exclusion of corneal grafts);

Severe, chronic or progressive renal or hepatic disorders;

Musculoskeletal diseases or disorders such as osteoarthritis with a high probability of surgery in the next five years;

Severe, chronic or progressive neurological disorders, including but not exclusive to:

Any dementia including Alzheimer’s disease;

Poorly controlled epilepsy;

Complex seizure disorder;

Cerebrovascular disease;

Cerebral palsy;

Paraplegia, quadriplegia;

Poliomyelitis;

Parkinson’s disease;

Motor neurone disease, Huntington’s disease, muscular dystrophy;

Prion disease;

Relapsing and/or progressive multiple sclerosis.

Cardiac diseases, including but not exclusive to:

Severe ischaemic heart disease;

Cardiomyopathy;

Valve disease with a high probability of surgical and/or other procedural intervention in the next five years;

Aortic aneurysm with a high probability of surgical and/or other procedural intervention in the next five years;

Significant or disabling hereditary disorders, including but not exclusive to:

Hereditary anaemias and coagulation disorders;

Primary immune-deficiencies

Gaucher’s disease

Severe autoimmune disease which may require treatment in New Zealand with immune-suppressant medications other than Prednisone, Methotrexate, Azathioprine or Salazopyrine;

Severe (71-90 decibels) hearing loss or profound bilateral sensori-neural hearing loss after best possible correction at country of origin, where significant support is required, including cochlear implants;

Severe vision impairment with visual acuity of 6/36 or beyond after best possible correction at country of origin, or a loss restricting the field of vision to 15-20 degrees where significant support is required;

Severe developmental disorders or severe cognitive impairments where significant support is required, including but not exclusive to:

Physical disability;

Intellectual disability;

Autistic spectrum disorders;

Brain injury;

Major psychiatric illness and/or addiction including any psychiatric condition that has required hospitalisation and/or where significant support is required;

Those with a history, diagnostic findings or treatment for MDR-TB or XDR-TB, unless they have been cleared by a New Zealand Respiratory or Infectious Diseases specialist upon review of their file or review of the applicant according to the New Zealand Guidelines for Tuberculosis Treatment.

If these medical conditions are evident (in most instances further reports from specialists are required to confirm this), then the applicant’s condition will be deemed to impose a significant cost and/or demand on the provision of New Zealand’s health services and therefore the individual will fail the requirement to demonstrate a satisfactory standard of health.

Other conditions that fail the good health requirement

In other instances, where conditions are not listed on the above list an individual included in the application will also fail the good health requirement where the following applies:

In the case of acute medical conditions, there is a relatively high probably that the condition or group of conditions will require health services costing in excess of NZ$41,000.00 within a period of five years from the date the assessment is made; or

In the case of chronic recurring medical conditions, over the predicted course of the condition or group of conditions, there is a relatively high probability that the condition or group of conditions will require health services costing in excess of NZ$41,000.00; or

The Ministry of Education has determined that there is a relatively high probability that the applicant’s physical, intellectual, sensory or behavioural condition or group of conditions would entitle them to Ongoing and Reviewable Resourcing Schemes (ORRS) funding; or

There is a relatively high probability that the applicant’s medical condition or group of conditions will require health services for which the current demand in New Zealand is not being met (irrespective of actual service costs).

In most instances where an individual is deemed to not meet the applicable standard of health, this does not necessarily mean the individual will not qualify for the grant of a residence visa.

Medical waivers – residence class visas

Immigration officers cannot automatically decline an application where an individual has failed the standard of health (in the opinion of the INZ medical assessor); they must consider all the circumstances of the applicant to decide whether or not they are compelling enough to justify an exception to INZ health policy being made.

The facts that immigration officers may take into account in their decision to grant a medical waiver include (but are not limited to) the following:

the objectives of Health requirements policy and the objectives of the policy or category under which the application has been made;

the degree to which the applicant would impose significant costs and/or demands on New Zealand’s health or education services;

whether the applicant has immediate family lawfully and permanently resident in New Zealand and the circumstances and duration of that residence;

whether the applicant’s potential contribution to New Zealand will be significant;

the length of intended stay (including whether a person proposes to enter New Zealand permanently or temporarily).

A balancing exercise is undertaken by Immigration New Zealand in relation to considering any medical waiver as to whether or not the circumstances of the particular case are balanced in favour of granting a waiver as compared to the actual costs involved with envisaged (or potential) treatment and/or services.

Seek professional advice and support early

Our firm has had considerable success in obtaining medical waivers from “standard” health related issues to exceptionally complicated health issues where significant funding will be required.

If issues are encountered with the processing of an application and/or a medical waiver is required contact us. We deal with these types issues on a daily basis, and have acted on most medical conditions or issues on a range of visa applications for applicants all over the world.

There is a fair amount of discretion exercised in the decision making process by Immigration in these matters, and we know where the line is, and how to get the application across that positive decision line.